Instructions

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journey.

Risk Factors and Prevention

Risk Factors

Age over 50, Family History, physical inactivity, and living
with inflammatory bowel disease are all potential risk factors for colorectal
cancer. 30% of our population is over age 50 and only half of adults in Ontario
are active or moderately active.

Risk Factors and Prevention

Obesity

Too many people are obese – increasing the likelihood that they
will get cancer.

Risk Factors and Prevention

Smoking

In 2005, the percent of adults who were current smokers
decreased to 22%. Still a long way from the 5% Cancer 2020 target.

Screening

Fecal Occult Blood Test

The probability of curing this cancer is 90% when it is
detected early. Fecal occult blood test (FOBT) is the recommended screening test
for those who have average risk for colorectal cancer. In 2004-2005, the percent
of the population screened with FOBT increased to 17%.

Screening

COLONOSCOPY

A positive FOBT test needs to be followed-up with a
colonoscopy. A gastroenterologist (or other specialist) performs the colonoscopy
and removes polyps or masses if present, then sends them to the lab to be
analyzed.

In 2005/06, close to 300,000 colonoscopies were provided in
Ontario, many of which were for colorectal cancer screening and surveillance.
Over 20% of these colonoscopies involved the removal of a polyp.

Diagnosis

Pathology Reporting

Pathologists process the specimen to determine if it is
cancerous and to help treatment planning.

Overall, 92% of cancer pathology reports include all of the
information required by Ontario's new quality standards. This helps provide more
accurate diagnosis and treatment.

Diagnosis

IMAGING

Part of the diagnostic period requires diagnostic scans such as
x-ray, CT scan, and MRI. Images of these scans are read by radiologists and then
sent to specialists to help plan treatment.

Diagnosis

STAGE CAPTURE

Determining the exact location, size, and spread of disease
("stage") of a patient’s cancer is essential for selecting the best treatment
for that individual. However, only 33% of gastrointestinal cancers are being
reported with stage data in Ontario.

It is recommend that, for adequate staging, at least 12 lymph
nodes be removed and reported from patients having colon or rectum resection for
cancer. 77% of colorectal cancer surgeries had 12 or more lymph nodes reported
between September and October 2006. This is a statistically significant
improvement from 70% in 2005.

Treatment

SURGERY

It is recommended that, for adequate staging, at least 12 lymph
nodes be removed and reported from patients having colon or rectum resection for
cancer. 77% of colorectal cancer surgeries had 12 or more lymph nodes reported
between September and October 2006. This is a statistically significant
improvement from 70% in 2005.

Surgical Wait Times: Surgery is most often the first point of
entry into the cancer treatment system, so waits for surgery have an impact on
the entire patient journey. About 80% of cancer patients will have surgery. 90%
of gastrointestinal cancer patients receive their surgery in 47 days, well below
the provincial target of 84 days.

Treatment

CHEMOTHERAPY

Chemotherapy Wait Times: Chemotherapy is an important part of
cancer treatment as it slows or stops cancer cells from growing, multiplying or
spreading to other parts of the body. For the past 3 years, half of colorectal
patients waited less than five weeks from the time of their referral to a
medical oncologist to the start of their treatment.

Drug Ordering: Errors can occur at any point from when a
physician writes a prescription through to the pharmacist filling the order.
Drug ordering software, that both alerts the physician or pharmacist to possible
prescribing problems, and electronically transmits the order to a pharmacy, can
prevent medical errors that can be associated with chemotherapy. There are plans
to implement these Computerized Physician Order Entry systems at 3 new sites in
2007/08. This will result in a projected increase of 60% of chemotherapy drugs
prescribed in Ontario being ordered electronically.

Treatment

RADIATION TREATMENT

Radiation treatment is an important part of cancer treatment,
used to shrink a tumour, destroy cancer cells, or provide relief from cancer
symptoms

Radiation treatment is usually only provided to rectal cancer
patients. Half of these patients started their treatment within 30 days of their
referral to a radiation oncologist. The provincial wait time has steadily
improved over the past three years.

Treatment

PATIENT EXPERIENCE

In 2006, over 70% of patients that reported mild to severe pain
responded that staff did everything that they could to control their pain or
discomfort.

Long-Term Survival / Monitoring and Follow-up

CANCER SURVIVAL

The proportion of colorectal patients alive five years after
their diagnosis is approximately 60% and has improved from 54% 10 years ago.

Palliative End-of-life Care

END-OF-LIFE CARE

Understanding patterns in end-of-life care can provide valuable
information about how patients dying of cancer are cared for in their last few
months and also helps to make decisions about how healthcare should be
structured to assist those in need of end-of-life care.

Research indicates that most patients prefer to die outside of
hospital. The acute care setting is generally not designed to provide optimal
palliative care for those dying of a terminal illness. However, the majority of
patients who died of cancer, died in hospital.